Yeltsin: healthier than the average Russian

Poverty, pollution and drink has slashed life expectancy, writes Phil Reeves

The contrast could hardly have been more graphically drawn. There was Dr Michael DeBakey, the 88-year-old American heart surgeon, wafting confidently into Moscow to minister to a man nearly a quarter of a century his junior.

The envoy of the New World, with its capitalist riches and obsession with longevity, had arrived to rescue a victim of the Old, with its post- Communist legacy of instability, fatalism, and unhealthy habits. The cardiologist looked as sprightly as a man half his age as he stepped off his aircraft, accepted a bouquet and walked into a tidal wave of questions about every detail of Boris Yeltsin's health.

The only glimpse that Russians received of the 65-year-old President was sadly familiar - a weak-looking figure, seen briefly on television before his medical team met to give the go-ahead to his bypass operation. The meeting of the two men symbolised the gulf that has opened up in the living standards between the former Cold War adversaries.

Both men are, of course, exceptional. For decades, Dr DeBakey's pioneering techniques have attracted the world's wealthiest, and most mollycoddled, people to the Texas Medical Centre in Houston, America's largest health care centre. His address book has included such names as Frank Sinatra, Lyndon Johnson and the Clintons.

Mr Yeltsin has endured the intense pressure of clinging on to power during the bucking-bronco ride of Russia's transition from Communism to the free market. The environment was one in which he often seemed more at risk from the bullet or the bottle than from his bad heart. But Mr Yeltsin is doing remarkably well by Russian standards. He has already survived seven years beyond the average life expectancy of a Russian male, which is 58 - in other words, most men in Russia do not live to draw a pension. American males, by contrast, can expect to live to 72.

Medical experts are uncertain over precisely why the figure has dropped so low, plummetting from 65 in 1991, and placing the country in the same league as India, Yemen and Egypt. It is the first country in history to experience such an abrupt decline.

The change has been dramatic. In 1993, 322,000 more Russians died than in 1992. Even during Stalin's bloody rule - which embraced world war and terrible purges - Soviet life expectancy rose from 44 to 62. By the late 1950s it was actually higher than the US, at 69. But there are plenty of contributing factors. Poverty, homelessness, disease, violence and suicides have grown with the unravelling of Russia's centrally planned economy. Figures released by the government yesterday showed that 30 million people were below the poverty line - a fifth of the population.

Half the country is forced to rely on sub-standard water supplies, polluted with a range of deadly substances from pesticides to radioactive waste. According to a report by Russian physicians, air pollution in 84 of the country's cities is more than 10 times the maximum permitted level.

Measles, diphtheria, tuberculosis, hepatitis, whooping cough, dysentery and even cholera have been spreading fast, no longer checked by the USSR's basic, but dependable, health service. These days many Russians cannot afford to buy medicines, most of which are costly imports, as their own pharmaceutical production has plummeted - one reason doctors estimate that those who contract TB are 17 times more likely to die from it than Americans.

Poverty has helped drive cardiovascular disease to epidemic proportions, not least because Russians have a fat-drenched diet, dominated by sausage and margarine products.

And then there is drink. Russia's men - whose life expectancy is 13 years lower than that of its women - are the world's heaviest boozers, consuming an average of a quarter of a litre of vodka every day. Directly or indirectly, alcohol plays a part in the death of 100,000 people a year. They are killed by liver ailments, drink-related violence or fires, freezing to death on the streets and motor accidents. "Men are just less healthy than women," says Viktor Mitkov, a Russian health analyst. "They smoke more, they drink more and they work in more dangerous jobs."

But Russia's catastrophe may not be entirely to do with the ills of the present. Scientists are now looking back to Soviet times, to see if a long history of environmental abuse - from dumping radioactive waste to building chemical plants which spew out toxic waste - is now coming home to roost.

It is a matter of some urgency. Russians are dying faster than they are being born. According to Russia's central bank, the 148 million population could shrink 12 million over the next decade.